The objective of the proposed research is to complete the test of hypotheses originally stated by the Pawtucket Heart Health Program. This research program, is one of three in the country designed to reduce coronary heart disease morbidity and mortality through the introduction of population-wide changes in risk behaviors and coronary heart disease risk factors. The research design is quasi-experimental with one intervention city and a sociodemographically comparable comparison city. Each city has a high proportion of blue collar workers of modest socio economic attainment. The intervention program has accelerated in Pawtucket beginning in 1984 and continuing through July 1991. Institutionalization of many program components is occurring and will be a major emphasis for the final 18 months of intervention. Careful epidemiologic surveillance of risk factors through cross-sectional and longitudinal surveys, telephone surveys, and carefully protocolled mortality and morbidity surveillance is an integral part of the research effort. Results to date include those of many formative studies, important observations on trends autonomous from the program efforts in the comparison city, and promising trends in rates of morbid and mortal events projected from random sample survey data. This proposal is to continue epidemiologic surveillance in the two cities for an additional five years so that the risk factor change - disease change hypotheses are properly tested.